COVID-19, Health, Philosophy, Spotlight

Sickness and Stoicism

In less than three months, COVID-19 has changed from a peripheral concern, barely registering in presidential debates, to the greatest global crisis since World War II. We are living in extraordinary times, and there is scarcely an industry or country that has escaped the impact of the new virus. In the United States, the Federal Reserve estimates that the unemployment rate could briefly skyrocket to 32 percent—higher than anything the country experienced during the Great Depression. People have lost their livelihoods. Many others are scared about what is to come when they develop a fever or cough.

Illness, financial hardship, and loneliness are, nevertheless, well-trodden paths. One man who can guide us along the way is Seneca the Younger, a Roman philosopher and statesman and contemporary of Jesus. Seneca suffered from asthma, and his condition sometimes left him bedridden and gasping for air. As he grew older, he even contemplated suicide because his affliction was so severe. Seneca’s lifelong illness, as well as his background in Stoic philosophy, gave him the insight he needed to find dignity and joy in periods of extended hardship. “There are times,” he once wrote, “when even to live is an act of bravery.”

You don’t have to test positive for COVID-19 to appreciate the consolation offered by Seneca’s wisdom. Pandemics are multitiered crises—the virus itself is only one among many serious disruptions in our lives. Maybe you lost your job after the economy in your country fell into a coma. Or perhaps you’ve recently been diagnosed with diabetes and you’re worried about how the virus might aggravate it. You may also be unsure how to endure physical isolation in the months ahead, even though you already know that several months of suppression and social distancing is vital if the spread of this highly infectious disease is to be contained. Seneca, who was once exiled to Corsica by Emperor Claudius, would have a word or two to say about separation from friends and family.

The starting point is to have compassion for ourselves. We are not, after all, in complete control of our initial reactions to a diagnosis or an unexpected layoff. As Seneca writes in his 11th letter to Lucilius:

When they face a crowd of people some men, even ones with the stoutest of hearts, break into a sort of sweat one usually sees on persons in an overheated or exhausted state; some men experience a trembling at the knees when they are about to speak; some a chattering of the teeth, a stuttering tongue or stammering lips. These are things which neither training nor experience ever eliminates. Nature just wields her power and uses the particular weakness to make even the strongest conscious of her.

Here, Seneca is meditating upon the terror induced by public speaking. Nevertheless, his lesson about humility before nature is broadly applicable. The true test of resilience lies in how we cope with our subordination.

It helps to clarify our thinking and identify threats. In his 78th letter to Lucilius, who at the time was fighting his own battle with asthma, Seneca lists the three most common fears that attack us during illness: “dying, the physical suffering, and the interruption of our pleasures.” With characteristic bluntness, he argues that to dread an illness because it might kill you is irrational. “You will not die because you are sick, but because you are alive,” he points out. “That end still awaits you when you have been cured. In getting well again you may be escaping some ill health but not death.” Seneca’s point is not that life is unimportant, nor that we should be indifferent to medical advice. Rather, he is warning that fear of the inevitable only compounds our suffering, because “in illness, the suffering is always bearable so long as you refuse to be affected by the ultimate threat.”

Prolonged anxiety is a petri dish for all sorts of poor health outcomes, including, ironically, an elevated susceptibility to infectious diseases. Seneca placed supreme importance on managing anxiety by occasionally running through the worst-case scenarios in our minds, instructing Lucilius to “always take full note of fortune’s habit of behaving just as she pleases, treating her as if she were actually going to do everything it is in her power to do so.” Confronting what scares us in a safe environment is, of course, an established technique in cognitive behavioral therapy. Seneca’s peers called this practice premeditio malorum, and there are simple guides to begin applying it immediately to our own situations. After doing this, “whatever you have been expecting for some time comes as less of a shock,” Seneca promises his friend.

Fear of mortality isn’t only bad for the individual concerned. It also creates problems for others.  Just a few days ago, a doctor from Farmington sounded the alarm about a large influx of New Yorkers fleeing their state to wait out the pandemic in Maine. In other words, people almost certainly already exposed to COVID-19 were so scared of the virus that they risked infecting the population of another state to find sanctuary. It is hard to imagine a more destructive and short-sighted response, although the frightened individuals who hoard cleaning supplies at supermarkets are doing their best.

The second disruption Seneca identifies is physical suffering. He concedes that pain is a part of illness, but he promises Lucilius a more bearable experience if he separates the sensation itself from exaggerated perceptions of it:

Provided that one’s thinking has not been adding anything to it, pain is a trivial sort of thing. If by contrast you start giving yourself encouragement, saying to yourself, “it’s nothing—or nothing much, anyway—let’s stick it out, it’ll be over presently,” then in thinking it is a trivial matter you will be ensuring that it actually is. Everything hangs on one’s thinking. The love of power or money or luxurious living are not the only things guided by popular thinking. We take our cue from people’s thinking even in the way we feel pain.

Seneca encourages Lucilius to fortify himself by thinking of famous individuals who have dealt with worse. “This is a time for recollecting all those individuals of exceptional courage who have triumphed over pain,” he writes. Identifying role models is an important practice in Stoicism, because they inspire us and are benchmarks for measuring our own behavior. In this case, they also can provide us with perspective, which in turn shapes how we experience our own suffering.

Literal pain, of course, isn’t the only way that diseases can debilitate our bodies. We can also lose the ability to sleep, to walk, or in the most extreme cases of COVID-19, to even breathe without assistance. These set objective limits to what we can accomplish while we are ill. Seneca’s answer is to shift our priorities. Or, as the modern Stoic author Massimo Pigliucci puts it, “we need to focus on abilities, not disabilities.” In one deeply moving passage, Seneca writes:

[I]f you meet sickness in a sensible matter, do you really think you have accomplished nothing? You will be demonstrating that even if one cannot always beat it one can always bear an illness. There is room for heroism, I assure you, in bed as anywhere else. War and the battlefront are not the only spheres in which proof is to be had of a spirited and fearless character: a person’s bravery is no less evident under the bedclothes.

The final disruption that Seneca acknowledges is “the interruption of our pleasures.” We’re all familiar with this, especially if we live in a state or a country that has imposed a stay-at-home order. Acting on the best advice of epidemiologists and physicians, multiple governments have shut down cinemas, weddings, bonfires, beaches, and all other non-essential businesses. These shutdowns are literally saving lives.

Still, all these interruptions working in tandem are potentially very stressful. Seneca argues that eventually, we’ll stop craving what we used to desire. “And there is nothing harsh about having to do without things for which you have ceased to have any craving,” he concludes. (What Seneca is describing is called hedonic adaptation, a well-attested phenomenon in human psychology.) Even with modern technology, however, physical isolation from family and friends is deeply unpleasant. Not to be deterred, Seneca asks us to reflect on the unique advantages of physical distance in another letter to his friend:

There’s nothing to stop you from enjoying the company of absent friends, as often as you like, too, and for as long as you like. This pleasure in their company—and there’s no greater pleasure—is one we enjoy the more when we’re absent from one another… Possession of a friend should be with the spirit: the spirit’s never absent. It sees daily whoever it likes. So share with me my studies, my meals, my walks. Life would be restricted indeed if there were any barrier to our imaginations, I see you, my dear Lucilius. I hear you at this very moment. I feel so very much with you at this moment that I wonder whether I shouldn’t start writing you notes rather than letters!

Throughout both his life and his writing, Seneca showed that everyone has the strength to act heroically—even if it means doing something as simple as staying glued to your couch. And if indeed “everything hangs on one’s thinking,” as he and his philosophical heirs frequently remind us, then this pandemic is just as much an opportunity as it is a curse. We can all show our descendants that we were the generation who stopped everything to protect our society’s most vulnerable.

 

Roy Wayne Meredith III is a recent graduate of the Columbia University School of Social Work and works as a case manager for a supportive housing program. He resides in New York City. You can follow him on Twitter @ThoreauSquad.

Comments

  1. I am disappointed but not surprised that Quillette is slavishly toeing the mainstream line concerning Coronavirus. If it didn’t, there would certainly be hell to pay, political and otherwise. I understand that. But didn’t Quillette build its brand on courageousness in the face of an oppressive establishment? That courage, evidently, only goes so far. Some dragons are too terrible to fight.

    To all those who still believe that “free thought” means anything, I urge you to look into this question and discover for yourself the truth of the matter. You will discover what I did–that this “pandemic” is a totally contrived publicity event with no basis in reality. I know this is a difficult conclusion to consider. But this is a difficult time–and if there was ever a moment to confront reality it is now. Trust yourselves. Trust your own reason–and your own sneaking suspicions–and you will not be led astray.

    Start here, with these unorthodox statements concerning the “pandemic” by 12 highly-credentialed experts. That will destroy the illusion of universal scientific consensus so forcefully maintained. Next, look over this paper by David Crowe, who shows that this epidemic is one of testing only. (Do you know how PCR tests work? Why not? Don’t you think you ought to, since that is the test being used to detect this virus around the world? You don’t need a degree to know. It’s actually quite simple. Almost everything in the world is actually quite simple, when it’s honestly and intelligently explained.)

    Next, look over this short ‘FAQ’. These bullet points will explode any lingering doubts in your mind. There are other resources that can be recommended, just ask. I am certainly not asking you to come to a conclusion without adequate reflection.

    I believe it is important that you understand the reality of this situation for two main reasons:

    • So that you are not paralyzed by fear. Fear disrupts the rational thought process. It cows and weakens you. It may even sicken you.
    • So that you can do your part in expressing your disapproval of this absurd and dystopian government-mandated “lockdown," which is destroying our wealth, our quality of life, and worst of all, our hope.
  2. The author talks about the looming economic crisis, and blames the virus. Sorry, but that is as a result of the hysteria, not the virus itself.

  3. Ok, I’ll bite.
    I followed your links as the current situation has cancelled my work schedule but not my rationality. Nothing shown there leads me to support your conclusion that;

    this “pandemic” is a totally contrived publicity event with no basis in reality.

    You are positing the existence of a hoax that co-ordinates the efforts of governments from China to the USA and from Norway to New Zealand.
    This would make theories like “The Freemasons faked the Moon landings” highly plausible by comparison.
    This attitude reminds me of a story I read (I can’t remember the exact reference) concerning a young officer in the trenches of WWI. After one particularly heavy artillery barrage he suddenly came to the conclusion that he was in the middle of a gigantic theatrical production. The soldiers were all actors, their wounds all make up, the gunfire and fortifications, special effects and stage scenery. It’s not exactly a sane response but an understandable one.
    Please for give my rather turgid analogies but it was as if the transmission system of his mind couldn’t deal with the torque required to get over the massive bump in the road he was now facing. His psychic gearbox started stripping teeth and grinding metal to the point where its’ wheels could spin more freely.
    I will listen to unorthodox opinions, in fact I think it’s essential to do so. Very hard questions about governments’ actions and principles need to be asked. But I have come to the conclusion that the actions of life on Earth, including human life, are governed by macro and micro biological principles, not by the dictates of a shadowy dystopian One World Government.

  4. “Seneca showed that everyone has the strength to act heroically—even if it means doing something as simple as staying glued to your couch.”
    How easily one gains heroism nowadays. Only the truly brave buy all the toilet paper.
    “We can all show our descendants that we were the generation who stopped everything to protect our society’s most vulnerable.”
    Or, possibly, the generation that ruined the economy out of fear. Also, this was not driven by compassion. All I ever hear is personal fear. I know it’s a common style of writing nowadays to soothingly jerk off your audience, and tell them how special they are, but I rarely hear of people actually expressing sadness over the dead, it’s more like “wear a mask, you filthy murderers, and stay away from me.”

  5. Your analogy is unfair to breathnumber. You simply proclaim him delusional. But that’s all you do. You don’t explain why the links he provided are compromised, you just say you read them. Here’s another analogy: https://www.spiegel.de/international/world/reconstruction-of-a-mass-hysteria-the-swine-flu-panic-of-2009-a-682613.html
    Now, there are some striking parallels between the swine flu hysteria and the coronavirus. Now you may feel the two are not the same. However: there is no case of a soldier imagining he was in a giant theatrical production rather than an actual war … and being correct in his assumption. To say there was hysteria over swine flu is not a delusion. People who questioned it at the time, who saw the theater, were right.
    Also, at no point, did he or his links posit a shadowy One World Order. Where did that spring from? All he and his links suggested was that the coronavirus’s fatality rate was exaggerated.

  6. All these preachy slogans are triggering my instinctive skepticism. While prudence is required, doing simple and reasonable things to slow transmission of the virus, at some point soon this shutting down all activity will be untenable. Most are willing to stay put for a few weeks to get our medical house in order but beyond that as an old guy I would not ask younger generations to suffer financial ruin to lower my health risks.

  7. These are the two key quotes that I used to get to One World Order

    this absurd and dystopian government-mandated “lockdown,"

    We know that lock downs are happening world wide. If the pandemic has no basis in reality then different governments are participating in the same contrived publicity event. Unless they are randomly coming to the same conclusion, then that’s one world government. Because they are not openly declaring their true motivations it becomes nefarious or shadowy.
    Don’t get me wrong, I want to hold government, all governments, accountable for their screw ups, and there certainly have been plenty of those. But I will start from observed facts and deploy logic and reason before I come to conclude a dystopian government publicity event. Not start at dystopian government and then go hunting for facts.

  8. Anyone not get the irony that a piece that’s essentially on stoicism in a crisis has descended into another whiny corona belly ache? Aren’t there enough threads for that?
    Maybe some negative visualisation of Nero for a boss might help…

  9. While I do think the danger of the coronavirus has been exaggerated, I wouldn’t peg its danger at zero. It can be fatal. That two nurses died is tragic, but it doesn’t prove that the coronavirus would wipe out swathes of the populace like the Spanish flu. For example, during the Sars outbreak, 20% of the infected were medical staff. Hospitals routinely have nurse shortages. Nurses often work long hours in stressful conditions, which impacts on their immune systems, and they are exposed to the very sick. Yes, much more should be done for nurses, and yes, we should appreciate the sacrifices they make a great deal more. Theirs is a true bravery. My problem is not that there should be no response to the coronavirus. My problem is governments setting the ship on fire to stop it from sinking.

  10. Always believe in cock up over conspiracy and you’ll be right for the vast majority of the time

  11. I respond here not as an epidemiologist, nor do I claim to have any knowledge beyond the mainstream media as to whether “social distancing” or “shelter in place” measures are most effective in decreasing the impact of COVID-19.

    I am a cardiologist who has been seeing COVID patients in the hospital over the last couple weeks, and I have numerous family members and colleagues who have been dealing with the crisis in Italy. These are all the credentials I need to make one definitive statement: COVID19 is not “just another flu”.

    Once we have better testing data, assuming we ever get it, we may ultimately learn that the case fatality rate is lower than initial projections. Additionally, there may be considerable debate as to whether the economic impact of shutting down the economy was worth the number of lives saved. I welcome all of those analyses.

    What won’t be up for debate is that COVID19 has the ability to overwhelm a medical system in a manner never seen with flu. In the Lombardy region of Italy, it was like a bomb went off: hospitals went from a baseline demand of 20-30 ventilators to a need for over 200 in a matter of 48 hours. More recently, in Detroit, a colleague of mine told me that her hospital went from 40 patients on ventilators to 130 in a matter of 72 hours. We simply never see this with seasonal flu, and it is silly to make any comparisons as such.

    In my own hospital, all I can say is that it is unsettling how fast these patients progress from stable to critical. I have cared for sick patients with flu for nearly 30 years…this is not in any way like the flu.

  12. You have my word that I will look into the sources you cite. Honestly, I understand the concerns that those with your opinion hold, I truly do. I have had the great frustration of being a life-long libertarian, and I don’t relish what I see in terms of federal/state policy in the United States in response to COVID; however, not to be overly repetitious, but in my clinical experience, this is not another flu. If it turns out that the CFR is low, in the range of 0.03 as some have suggested, due to high prevalence of infection, it could still overwhelm our systems in the short term.

    Let’s do the math. Assuming roughly 350 million Americans, if only 30% were ultimately infected, that would be 105 million infections. Let’s say the case fatality rate is only 0.03%, that would translate into 315,000 deaths (roughly 6-7x the average number of flu deaths per year). Although most infected individuals would be asymptomatic, or mildly symptomatic, it appears that up to 5% may require ICU care (recognizing that lack of testing may be the reason for such a high value). Let’s go more conservative and use 2.5% need ICU care, that is still 2.6 million additional ICU patients as a result of COVID. If you don’t have experience working in a hospital, it is hard to grasp how badly that would strain the system.

  13. My experience has mirrored that of OldWise1. Right now I’m at working at a hospital close to Seattle, pulling a shift helping coordinate our labor pool, which matches idled clinical staff with the huge number of Covid-related shifts that need to be filled. It’s complicated by the need to take education, training, certification and licensing into account, and to hopefully not violate labor law or union contract stipulations. Loads of fun, lots of moving parts.

    I’m paying no attention to the news, or to anyone’s accusations, predictions or conspiracy theories. I just care about what needs to be done right now. We’ve got upwards of forty positives, with another twenty or so pending.

    Most people, myself included, underestimated the virulence, transmissibility and asymptotic hiding of this nasty little fucker, and I’m not interested in “educated” guess work anymore. I’ll wait until it’s all over so we can hopefully look back at it rationally. And thereby be more ready for the next one.

    First sentence of my post here is worded inaccurately, I should have said “my hospital’s experience has mirrored that of OW1’s facility, in terms of the volume of cases and a similar rate of cases requiring a ventilator.” OM1’s own experience involves direct patient care up on the floors, mine does not, except for deliveries (mostly meals, our local restaurants have been wonderful). My hat is off to him or her.

  14. I think the irony goes even deeper than that. Seneca said that “Life is long if you know how to use it.”

    we were the generation who stopped everything to protect our society’s most vulnerable.

    This seems like the opposite course of action to the one a generation of stoics would have taken.

  15. we were the generation who stopped everything to protect our society’s most vulnerable

    Nonsense. Children are our most vulnerable. Who is thinking of them? Particularly those who are now locked in houses with abusive parents with no outside monitoring from schools or relatives, while some of those parents are extraordinarily stressed due to job losses or simply living under house arrest in a police state.

    Even children with good parents now have had their educations interrupted, their access to their friends and routines and activities curtailed, their sense of safety in the world attacked, and possibly their economic prospects shattered.

    Anyone arguing for these ‘lockdowns’ and patting themselves on the back for their attention to the ‘vulnerable’ ought to be ashamed at what they are doing, unwittingly or no, to children.

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